- In patients with advanced endometrial carcinoma, adjuvant chemotherapy plus radiation (CRT) fails to improve recurrence-free survival (RFS) vs chemotherapy alone.
Why this matters
- Chemotherapy alone remains the standard of care; findings suggest adding radiation may decrease tolerance and result in incomplete delivery of chemotherapy.
- Phase 3 Gynecology Oncology Group (GOG)-258 trial of 736 patients with International Federation of Gynecology and Obstetrics stage III-IVA endometrial carcinoma, randomly assigned to adjuvant 6-month platinum-based CRT or chemotherapy.
- Primary outcome: RFS (time to relapse/death).
- Funding: National Cancer Institute.
- Median follow-up duration, 47 months.
- 75% of patients in the CRT vs 85% in chemotherapy group completed all planned chemotherapy cycles.
- 60-month RFS was 59% with CRT group vs 58% with chemotherapy (HR, 0.90; P=.20).
- At 60 months, CRT was associated with a lower 5-year incidence of:
- vaginal recurrence (2% vs 7%; HR, 0.36; 95% CI, 0.16-0.82); and
- pelvic and para-aortic lymph-node recurrence (11% vs 20%; HR, 0.43; 95% CI, 0.28-0.66).
- Distant recurrence was more common with CRT (27% vs 21%; HR, 1.36; 95% CI, 1.00-1.86).
- Fewer grade 3-5 adverse events were observed with chemoradiotherapy (58% vs 63%).
- QoL: no clinically meaningful difference was observed at 70 weeks.
- OS data were not mature.